Dr Mari's Faith Stop

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Thursday, December 27, 2018

Last month, I had the privilege of talking to the Orlando Sentinel about physician wellness, burnout prevention, and my upcoming book, Recapturing Joy in Medicine. I am thrilled that a local reporter is covering the story of how the practice of medicine feels like an obstacle course in 2018, and how this continues to affect physicians and patients.

Follow this link to hear the 30-minute podcast interview and read the article. Feel free to share it with medical students, residents, fellows, physicians in practice, training programs, and hospital systems. You may contact me here to receive a message as soon as the book is available.

My hope is that Recapturing Joy in Medicine will encourage my colleagues to speak up and support one another to rise above the boulders on our path.

Tuesday, December 25, 2018

Last night, I was blessed to attend a moving Christmas Eve service with our church family. I sat with our boys, my husband officiated, and our young daughter joined the sopranos in the adult choir. Surrounded by music, she had front row seats to the strings and wind sections and loved every minute of it. Songs like The First Noel and O Come, O Come, Emmanuel filled my heart with the joy of Christmas in a special way, knowing one of those voices came from our sweet daughter.

Of all the heartwarming songs, the most special for me this year was Silent Night. As the clergy knelt at the altar, their backs to the congregation, we were drawn to join them to worship the newborn king. I felt like one of the shepherds beholding the child at the manger. Time seemed to stand still as these scriptures reminded me of the hope of God's promise,

For to us a child is born, to us a son is given, and the government
will be on his shoulders. And he will be called Wonderful Counselor,
Mighty God, Everlasting Father, Prince of Peace. (Isaiah 9:6)

The wolf will live with the lamb, the leopard will lie down with the goat, the calf and the lion and the yearling together; and a little child will lead them. (Isaiah 11:6)

My child, along with everyone at the altar, led us to worship the child who leads us to a life of grace, of mercy, of forgiveness. He ushered an eternal kingdom in a temporal, broken world; a kingdom of justice and grace in a world in desperate need. In his kingdom of peace, love and faithfulness meet together; righteousness and peace kiss each other (Psalm 85:10).

When I lie down to sleep tonight, memories of this Christmas day will fill my mind. I will recall our festive hats, gifts exchanged with the best neighbors, our family walks, hugs, and laughter, the clever homemade Jeopardy game I lost gladly to well-educated children, meaningful texts full of grace and cheer, phone calls, invitations, cookies, and conversations with loved ones not seen nearly enough. I will also recall specific gifts, like the perfect laptop case and the various homemade gifts that will bring lasting joy.

And after all quiets down, my heart will swell as I give thanks once more for the greatest gift of all, the gift that makes all good things possible. James 1:17 reminds us that every good and perfect gift is from above, coming down from the Father of the heavenly lights, who does not change like shifting shadows. As I lie down to sleep, I will give thanks for the One who came wrapped in swaddling cloths to enter an imperfect world and fill it with light, mercy, and grace.

This week we were blessed to see—for just a few seconds—a full moon over our Christmas tree. Having visited Assisi, the home of St. Francis, this summer, my first reaction was to welcome
Sister Moon, as he called her. Then I thought of John 9:5, where Jesus
proclaimed,

I'm so glad I took a photo right away, for about two minutes later, we couldn't see the moon anymore.

The good news of Christmas is that the light of Christ does not dim or depart the heart that welcomes it. The good news is that he's here to stay, meeting us right where we are, and replacing our chaos with order, our fears with hope, and what is dead with life. And the great news is that he came for all, just as we are.

This Christmas, perhaps more than ever, I am so grateful for the gift of life, health, friendship, and love. I am grateful for the gift of faith, family, and love. And I am grateful for the gift of time to embrace and know the One who made himself small and vulnerable—for you and for me.

I wish you a blessed and meaningful Christmas season full of all the goodness that comes down from the Father of lights.

Friday, September 21, 2018

A year ago yesterday, on September 20, 2018, Hurricane María made landfall in Yabucoa, Puerto Rico at 6:15 AM, changing the island in an instant. From that day on, what had been easy became difficult or impossible and, for nearly everyone, the basics previously taken for granted were suddenly gone, overnight. Although many outside the island didn't grasp how unprecedented these events were, the uniquely hospitable and resilient people of Puerto Rico faced the disaster with inspiring generosity, grit, and grace.

Yesterday, beauty and hope filled Yabucoa's skies at exactly the same time as the storm hit a year ago. Alberto Carrión joined the University of Puerto Rico Choir (Cayey campus) to sing Amanecer Borincano, which speaks of a new dawn in the land of Borínquen, the Taíno Indian name for the island of Puerto Rico.

Directed by internationally renowned choir conductor, Amarilis Pagán-Vila, the choir greeted the one-year anniversary with joyful singing. Sprinkled throughout is the heartwarming song of our beloved coquí, as if to remind us, "I'm still here. Don't you worry. I'm still here."

This beautiful tribute to the spirit and soul of the people of Puerto Rico reminds me that a rainbow awaits us after every storm even if, at times, we can't discern it fully or must wait for its full display.

May this gesture of hope fill our hearts with the joy of living and help us count our blessings today and every day. And may it move us to pray for and support those now finding their way to a new life after Hurricane Florence as well.

Saturday, May 12, 2018

In 2018, healthcare has become an obstacle course. As physicians, the most highly-trained professionals in the healthcare team, we now spend 2/3 of our time on administrative tasks and 1/3 on patient care. We didn't sacrifice years of our lives and incur huge amounts of debt to become data entry clerks. No wonder the rates of burnout are so high!

Although the challenges are real, this is a time of tremendous opportunity. Physicians are rising up, empowering one another and advocating effectively for patient safety and for our noble profession. This is one reason I've partnered with Reimbursement Rx to help equip physicians to get paid for the work they already do while remaining focused on what drew us to medicine:

Caring for people with excellence and compassion.

This summer, I'll be the guest speaker June 16-17 in Englewood, New Jersey during an information-packed seminar to empower our colleagues. Join us to learn about:

Contract Negotiation

Proper Coding & Billing

Health Insurance & Medicare Contracting

HMO & Foundation Contracting

Contracting SMARTER as a Healthcare Professional

RVU's & CEO's

... and so Much More!

As guest speaker, I will inspire and help equip physicians with practical ways to recapture the joy and heart of medicine.

Wednesday, October 25, 2017

As a physician leader, I recognize the public needs to be educated as to what's happening in healthcare, for the crisis we're experiencing impacts everyone. For instance, there are now ten non-clinical administrators for every physician in this country. This means a greater portion of every healthcare dollar goes to paying for staff who have nothing to do with direct patient care. Yet, these administrators dictate and control much of what physicians can and must do (from time spent with each patient to supervisory responsibilities for others in the healthcare team with an unfair burden of liability). Physicians are forced to see more patients in less time, many of whom are sicker than ten years ago and on more medications. Despite mounting and exhausting obstacles to excellent, compassionate care, physicians strive to care for people every day according to our high standards, placing patients first.

As medical care becomes increasingly complex with the epidemic of obesity, diabetes, cancer, and many other chronic illnesses, the standard of care has been dropping, with an explosion of non-physician team members with significantly less training than physicians being given clinical responsibilities for which they are not adequately trained. Although they have an important role to play as valued members of the healthcare team, in many settings they simply don't have adequate supervision. And while the growth in physician numbers has been stunted for over forty years (see graph below) and there are not enough residency spots for every graduating, well-trained medical student, the numbers of non-clinical (and very expensive!) administrators and non-physician team members continue to rise exponentially.

In 2017, physicians have less and less control with more responsibility and liability. No wonder physician burnout is at an all-time high. What's truly remarkable is that it isn't higher, and I believe that is due to our high levels of resilience, commitment, and dedication to our profession and to our patients. Although this poem is different from most of what I typically post here, I was inspired to write it after becoming a patient and experiencing the "other side" of healthcare. Like most physicians I know, I long for the day when healthcare returns to placing patient care at the center of all we do, with the high standards of care that are a foundational part of physician training in medical school, medical residency training, and medical fellowships.

Here's my poem, written to inspire my colleagues to say, enough is enough, and stand up for patients and a high standard of care. Yes, this takes courage, and it is precisely what's needed. (An explanation of the many acronyms is included below.)

A New Lexicon for
Physicians

by: Amaryllis Sánchez Wohlever, MD

Imagine if PQRS
and ICD-10,

EHRs and the looming MACRA,

MIPS and APMs

all stood for something else,

like measures of meaning and care

aligned with what patients need

and with who we are:

true servants at heart.

These sly abbreviations

champion some other dream

that hijacked our profession

and disrupts the healthcare team.

But we refuse to abbreviate care,

cut corners, detach,

and forget who we are.

I dream of autonomy

and its friend, common sense,

and that sacred relationship we all still defend.

I dream of scaling that fence

built by faceless EHRs

that split

my vocation … from … the human person

I vowed to assist.

So why not rename

the despised click-click-clicker

that keeps us a
– u – t – o – m – a – t – e - d

and every misnomer that traps us

‘til we’re duly subordinated.

Here’s a new dictionary of medical terms

born of our noble dream — not theirs.

Physician, Arise! This is my earnest plea.

Quit playing someone else’s maddening game.

Rules that hinder, intrude, disrespect, and inflame.

Success is, now, L I S T E N — up to you and me.

Mandates and regulations keep choking.

Administrators blindly add more stress.

Care suffers while we smolder, too busy to voice our distress.

Remember your Hippocratic Oath?

Anyone else take that pledge?

We know what matters most.

Our patients are first.

Make another vow, for the future’s at stake.

It’s time to stand up; we must stay wide awake.

Patients deserve much less haste, something better.

Sacred relationships front and center — forever.

I believe in you,

Colleague. You’re ready!

Dare to speak your truth and to STAND!

10 thousand more voices all over this land.

A new future requires a return to the basics.

Practice your craft. We cannot be complacent.

Make everything count for you and your patient.

It is time to heal our profession.Let’s scrub in and start healing our nation.

Let us all work together to see

Everyone’s

Health

Restored.

Including our own.

Physician colleagues, stand up!

Dr Mari

PQRS: Physician Quality Reporting System

ICD-10: International Classification of Diseases and Related Health Problems

Tuesday, October 10, 2017

I wrote this simple poem as a teenager growing up in the metropolitan city of San Juan, Puerto Rico. I
wrote it while driving to San Sebastián with Mami to visit my beautiful Abuelita Patria
and the rest of our family on the western side of the island. Many of
those familiar, picturesque roads to San Sebastián are now gone, swept away by hurricane María. I'm so thankful that they live on in my mind, where I continue to enjoy the landscapes while we all await their return
—
in time.

My heart longs for my island and its
people. The images are tough to assimilate so, every day, I turn my longing into fervent prayers. This poem I wrote so long ago is about my patria (my homeland) and the love in my heart for the jíbaro in the mountains, inland, where they live surrounded by the beauty of God's creation yet, at times, lacking luxuries of modern life like cement roofs and walls. This, of course, makes them more vulnerable to the destruction brought on by hurricanes.

The jíbaro is the backbone of our culture and
the birthplace of island hospitality. They are beautiful and kind, always giving cheerfully of what little they have ... and now they desperately need us to be generous to them. I know they continue to work tirelessly every day to restore the land, try to salvage crops, and (especially) to help and support their neighbors, regardless of the cost. I am so thankful for the outpouring of generosity and good will toward the people of Puerto Rico, and I pray it continues until every need is met.

Here is my simple poem of love for the kindness, generosity, and simplicity of every jibarito who stole my heart years ago, and taught me that joy and contentment are birthed by giving...

As we all continue to process the ongoing events in Puerto Rico, the message of hope in this short sermon helps comfort the heart and settle the soul. May it help us all as we continue to do what we can in the midst of this tragedy, for we know and trust that "God weaves goodness into every story" (Fr. Russell).

Friday, October 6, 2017

As the days and weeks go on, my heart and prayers remain in Puerto Rico, where I grew up, where I learned to walk, talk, and pray. On the island, I experienced firsthand the fellowship of family, the hope and joy of faith, the hospitality and generosity of my people. As I picture what's happened there
—
on my Isla del Encanto—
I am heartbroken, like so many of us who love our island and its people. We are all still grieving, and we need to grieve, for that is how one adapts to change and loss. The losses are unimaginable, and thousands of people are still suffering.

Yet, in the midst of the emotional and literal darkness (90% of the island remains without power two weeks after the storm), kindness, goodness, and love continue to rise unabated. Generosity, perseverance, and hope are displayed daily in countless ways, and this is where I choose to focus my eyes, my mind, and my heart.

Yes, there is hope, though not without you and me!

As I see images of the destruction left behind, countless memories of a happy childhood on the island emerge as if to wash away the reality of the present moment. These memories fill me with joy and hope for my people there, and inspire me to continue to do what I can to help them rebuild and heal. Though we are all heartbroken, the way through the heartbreak is unceasing prayer coupled with action. I have found that as I pray and do something to help someone each day, my heart heals a bit more, and hope endures.

Many people have asked me how to help and where to donate (I thank you from the bottom of my heart!). I had previously shared about Unidos por Puerto Rico, a non-profit started by First Lady Beatriz Rosselló.

Lin-Manuel Miranda, beloved boricua and creator of the Broadway hit Hamilton, assembled artists like Juan Luis Guerra, Rita Moreno, Marc Anthony, and many others to produce a song for Puerto Rico titled Almost Like Praying. In an inspired tribute, they mention every municipio in Puerto Rico by name, from Fajardo to San Sebastián to Mayaguez, and including the smaller islands of Vieques and Culebra ... not a single town or their people forgotten. At the end of this new music video is another opportunity to donate to help feed the people and rebuild the island of Puerto Rico. Listen for a little treat of a song at the very end (music to my ears!). Keep listening after the song for an interview where Lin-Manuel explains how the song was produced in such a short amount of time.

May our songs of praise never cease (pictured is our native coquí!)

Relying on God's mercy displayed throughout the world in the generosity and love of His people,

Dr Mari

Open the gates that the righteous nation may enter, the nation that keeps faith. You will keep in perfect peace him whose mind is steadfast, because he trusts in You. Trust in the Lord forever, for the Lord, the Lord, is the Rock eternal.

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